Timing of ADHD treatment had little influence on the risk of a decline in language arts performance.

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MONDAY, June 25, 2012 (MedPage
Today) — Starting treatment for attention-deficit/hyperactivity
disorder (ADHD) sooner rather than later appears to lower the likelihood of a
decline in academic performance as children move from elementary to middle
school, researchers found.

Among Icelandic children receiving ADHD medications, those who started
treatment later had greater risks of a decline in math performance, an
association that was stronger in girls than in boys, according to Helga Zoëga,
PhD, of Mount Sinai School of Medicine in New York City, and colleagues.

The timing of ADHD treatment had little influence on the risk of a
decline in language arts performance, the researchers reported online ahead of
the July issue of Pediatrics.

The difference between performance in math and language arts is
"not entirely surprising," according to Andrew Adesman, MD, of the
Steven & Alexandra Cohen Children's Medical Center of New
York.

"In 1937 — 75 years ago — when children were
treated with stimulant medication for the first time, the boys referred to the
medication as their 'arithmetic pills' since they noticed their math
performance improve," Adesman said in a statement.

"More recently," he continued, "math performance (speed
and accuracy) has proven to be a very sensitive and reliable clinical measure
of medication effectiveness in many research studies."

Zoëga and colleagues noted that previous studies have shown that
mathematics disabilities and language disorders involve different parts of the
brain.

"Possibly," they wrote, "stimulant drug treatment has
more positive effects on the cognitive function underlying mathematical ability
than on that underlying language ability."

Although stimulants have been shown to improve the core symptoms of
ADHD, there are few long-term data on their effect on academic
progress.

To explore the issue, Zoëga and colleagues looked at data from 11,872
children ages 9 to 12 born from 1994 to 1996 who took standardized tests in the
Icelandic school system in the fourth and seventh grades. Information came from
the Icelandic Medicines Registry and the Database of National Scholastic
Examinations.

About 8 percent of the children were treated with ADHD drugs at some
point during the study period. Nearly all of those treated received
methylphenidate (96 percent); 9 percent also received atomoxetine and 34
percent received another psychotropic drug concurrently.

The children who started taking ADHD drugs between the fourth and
seventh grades were more likely to decline in test performance — defined
as a drop of at least 5 percentile points — compared with
nonmedicated children.

But there were also differences seen within the treated group; later
treatment initiation (25 to 36 months after the fourth grade tests) was
associated with higher rates of performance decline compared with earlier
initiation (within 12 months of the fourth grade tests).

Declines in math were seen in 73 percent of those who started later
and 41 percent for those who started earlier. Language arts declines were seen
in 43 percent of those who started later and 39 percent of those who started
earlier.

After adjustment for potential confounders, starting later was
associated with an increased risk of academic decline for math, but not for
language arts.

When broken down by sex, the relationship between starting treatment
later and a decline in math performance was stronger for girls than for
boys.

That finding could be due to chance or could be related to sex
differences in ADHD symptoms, according to the researchers, who noted that
girls with ADHD typically present with symptoms of inattention and have less
hyperactivity than boys.

The authors acknowledged some limitations of the study, including the
lack of information on the underlying ADHD diagnosis, subtype, or severity, on
potential comorbid learning or psychiatric disorders, or on concurrent
behavioral therapy or educational school services received by the
children.

In addition, they wrote, it is possible that children who started ADHD
treatment earlier may have more family or social support to help them in
school.

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